Transcript for
Child-focused practice in adult-focused services

Runtime 00:25:50
Released 23/9/19

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

 

Dan Moss [00:00:08] You’re with Dan Moss, and today I’m talking with Jonathon Main. Jonathon is a Social Worker and the Executive General Manager of Policy and Programs at Relationships Australia, South Australia. Jonathon has over thirty years experience in the provision of services to children and families with complex needs, both in clinical and management roles in the health, welfare and non-government sectors. The major focus of his work has been in the provision of services that promote the healthy development of children, young people and families. And in community engagement programmes that promote social inclusion and participation in today’s episode. We discussed some of the implementation drivers that Relationships Australia, South Australia that promote child focussed practice in services that work mainly with adults. Jonathon shares his insights on how screening, assessment, practice, policy, recruitment and supervision all have a role to play in ensuring that children’s social and emotional wellbeing is at the forefront of all service delivery to adult clients.

 

[00:01:09] Jonathon, welcome. In your long history of working in both NGOs and government organisations, do you think that child focussed practice has become more commonplace, particularly in services that work predominantly with adults?

 

Jonathon Main [00:01:24] Yes, I think it has. I mean, I think if you look back over really the last twenty or more years, our knowledge of child development, child development milestones, our understanding of neuroscience. And particularly the impact of our understanding about neuroplasticity in the brain, not just in the early years, but now in the first thousand days, I think has really given us a very strong idea of how future life course outcomes in terms of health, educational outcomes, abilities for social and economic participation, have all been much enhanced by our understanding of child development and in neuroscience. So these things, I think, actually underpin much of the work across the health, education and community service sectors. I think also there’s within that a lot more recognition that even for people who aren’t involved in delivering services to children, understand the effects for children of particular challenges or difficulties that parents have or adults may have, can be seen through the lens of a child. And so to that extent, I think our sense of being child focussed in our practice has become much stronger. And I also think our child inclusive practice where we are actually directly involving children or divorced with children in our work, is something that has grown significantly in the last probably twenty or thirty years, really. And that that idea about neuroscience and neuroplasticity isn’t just something that is fairly years or the first thousand days. We also understand that there are particular milestones and transition points, particularly going into adolescence, but also later in life where there is still capacity for us to understand from neuroscience an individual’s capacity to learn and develop. And I think that informs our thinking in the way we deliver services and the way we use our knowledge of child development within neuroscience lens.

 

Dan Moss [00:03:27] So attracting staff with common understandings of the importance of child focussed practice. Can you tell us a little bit about how you’ve gone about that within your current services at RASA, and what have been the most important aspects of that?

 

Jonathon Main [00:03:41] A lot of attracting staff is about being clear about who we are, what we’re doing, and I guess as an organisation, we put that fairly upfront in what we’re doing. I think most organisations do that in their own lives for all of our services. We have a very whole family focus anyway. I think that a couple of important elements to that. One particularly is having a universal and holistic screening tool that we use, which in our case is the family doors, the detection of risk. And that’s an important aspect of our practice because that covers all of our services and really saying we’re wanting to screen for all issues and risks that people might present even as an opportunity for a very specific and effective medical service like, say, gambling help service. So for staff coming to our organisation, people coming to our organisation, they understand that these are important elements of our clinical framework and their clinical practice. And these are things that are underscored by having a robust client relationship or client management system, information system and robust data. So this is making sure that we’ve got a commitment to good clinical practice underscored by good clinical information generated by robust screening and assessment risk assessment processes. So that’s kind of an up front, sort of front and centre, I should say, element of how what do we know about us is. These things are the impact of what we are looking for when we’re recruiting staff is an expected element of being proud of RASA and no other organisation to that in similar ways. I think in our case, we probably make that very evident through the sorts of of ways that we promote the service, the ways that we talk about what we do. The ways we then recruit staff and looking for the sort of skills and commitment from people who really are wanting to practice in that space.

 

Dan Moss [00:05:37] So just looking at that from a recruitment lens for for a second then, are there particular questions in recruitments, in adult focus services that might be asked to kind of find practitioners with these skills or knowledge?

 

Jonathon Main [00:05:54] Our family doors a screening tool that something is written in the position description. So people can’t apply for a job not knowing that we use Family Doors, we use it as a universal screening across all our services. It’s a holistic screen within apposition descriptions. It’s also evident that we have a good or a sound robust clinical governance framework. So supervision, willingness to be part of regular supervision with line management and in a clinical practice leadership framework as well. Support for professional development becomes another part of that. So all of those elements are written into a position description, which obviously we have been asking about. And that’s in addition to other things, like a sound knowledge of child development, a sound knowledge of the socio political context of people’s lives and how adversity impacts on their lives, whether that’s through dealing with issues in relation to child protection or family domestic violence or gambling related problems. Or more simply, relationship difficulties that people can experience wanting to seek a service. So those elements are incorporated within our position descriptions. We contextualise those key elements in saying this is what a practitioner is required to do in RASA. And if that’s what you’re up for, then we’ll be asking you about that at interview. And that’s something particularly around how do people reflect on the knowledge of child development. And one of the key milestones that might impact in the case of people who are working in services, delivering directly to children. In the case of a practitioner who might be recruited into services that are adult focussed, you will be asking about their knowledge and understanding of child development and how that might be evident in helping them understand adults who are presenting for support. So it is very much a matter of saying the totality of a person’s presenting circumstances is seen through a variety of lenses. And we really want people to understand that the lens of children and the lens of those broader, if you like, socio-political context of people’s lived experience are important ones that we need to ask at interview. We would like to obviously see that demonstrated in the sorts of background experience.

 

Dan Moss [00:08:03] Thanks, Jonathon. So tell us a little bit about the evolution of a Family Doors at Relationships Australia, South Australia. And maybe how this is put children’s social and emotional wellbeing at the focus of all practice?

 

Jonathon Main [00:08:17] So a significant part of our services involves providing mediation counselling for high conflict families, both pre and post separation. In the context of particularly post separation, high conflict families. We’ve been aware there’s a number of other agencies and in fact, as we know in the community of the particular risks, fatal risks for most often women and children in those circumstances. And through our own experience, felt that we needed to have a much more robust and integrated tool than the range of tools that are variously available for the purpose of screening and risk assessment. We also wanted to make sure that we were getting from both parents their perspectives not just on their children, but their perspectives on their partner or ex-partner, their perspectives or their safety and in fact their partner or ex-partner safety. So realising that what we didn’t have in the various separate risk screens was something that was integrated and was holistic. And so in that context, we’ve then said, well, this is something that we need to be doing across all of our services. Including if people are coming for an individual service as an adult for something like say, gambling help.

 

[00:09:37] We also know, for example, in our homelessness programmes, one programme in particular where we support women and children who are homeless as a result of having domestic violence, if we were simply using an individual screen around family domestic violence, risk and safety. We might miss important information if we’re not also engaging the parents around. What does this mean for the children? And so we’ve realised across all of our services, including our community development, multicultural services, around our specific adult specialist support services, as well as our family counselling and post separation services; that a holistic screening, universally applied is a really important foundational element of a robust clinical engagement with families.

 

[00:10:27] And through the Family Doors process has it become evident that a focus on children is actually, has increased over time through the practice that is often even in adult focussed services?

 

Jonathon Main [00:10:42] For the clients that we see, about two thirds of our clients are parents, whether or not they’ve actually presented for a parenting or relationship concern. What was interesting for us about that research that we did have our own data is that people presenting to, if you like, generic services are not specifically family or parenting programmes, were showing higher rates of parenting stress and concerned about their parenting than people within those programmes where they were coming along saying ‘I want some help with my parenting or I’m concerned about my children’. So that really told us that without asking the sort of questions that we are within a framework like Family Doors, we wouldn’t be getting information from those other clients about concerns related to children. So we have somebody who comes along to say a gambling help service. They might be coming along with a host of issues related, obviously, to their gambling. It may also include drug and alcohol related problems. It might also inevitably include some kind of financial difficulties. And we now know what impact this might be having for those who have children on their children. We’re getting information from them about their concerns, about their parenting of their children, which we wouldn’t normally be asking if they were just coming for a straight up gambling service. So this is important information that then helps us say, well, what other support to people need? And so make sure that we are then able, in what I will say is a more robust, robust clinical governance framework, to say we’re able to better identify and assess the risks and safety issues.

 

Dan Moss [00:12:23] So has your experience of Family Doors then told you that if you ask parents the questions, they’ll more than likely answer in a truthful and genuine way?

 

Jonathon Main [00:12:35] Yeah, absolutely. I mean, we certainly find that and we use Doors not just in a paper version, but we also have an Internet version so people can then simply do it through their electronic device before a session with us. We know from our own analysis of researching and surveying with clients their their feelings about using the Doors screen. And these people are overwhelmingly comfortable with using that, partly because we are asking. And I guess that’s one of the things you I mentioned earlier about restorative practice, and that is something that we see as important as an organisation. One of the underpinnings of restorative practice is about being able to have difficult conversations in a supportive environment. One of the first ways is that we indicate to clients that we’ve had difficult conversations is by being fair to ask difficult questions, whether it’s in person or by way of a screening app or screening tool. So clients overwhelmingly have said that they are happy to have these questions asked of them. We know that by large, people are absolutely honest in the way they do that. We also know that like with any screening or risk assessment process, people will be prone to, depending on the circumstances, either minimise or discounting the significance of a problem or even denying the problem is there. The advantage for us in asking out front is we communicate the message that we’re interested in knowing and we want to talk about these.

 

[00:14:03] We can also see from particularly, for example, if we’ve got two parties, two parents, let’s say separated, who have competed the Door screen, we have a double description from each of the parents about the concerns in relation to the other. So if one person were to answer that something wasn’t a problem, like being harsher than usual in their parenting or, for example, the issues of violence weren’t present and the other parent were to say the opposite. Then we’ve already got something that tells us, ok we need to ask a little bit more into this. That might be something that we do over the space of time and we’ve often come back to, if not the whole Door screen, certain areas of risk that are identified in that screen throughout the process of our engagement. So we understand if some people come into a service and one very clear and obvious example is men who use violence, for example, often don’t put their hand up or say, I’m coming here because I’ve got a problem with violence. Many do, but there are some who do it because they feel like they are being coerced either by court or a legal process, or they feel like they don’t have a choice because their partners told them that, you know, if they don’t come to the service, then their relationship might be in difficulty or in jeopardy I mean. So we already know that for, in certain circumstances we can expect people not necessarily to be telling us exactly as it is. But once again, we start that process off by saying ‘we are interested to know, we want to know. We’re concerned about a whole range of issues relating to what’s going on in your life. Even though you want to come along for one specific thing’. So I think that’s a communiqu, sort of a powerful message to communicate in a restorative kind of way. It is saying we want to have those difficult conversations and we will ask into these spaces. Obviously, respectfully and appropriately within that context. Certainly screening risk assessment, our use of Doors and the ways of we then come back to that, are important elements of engaging those conversations.

 

Dan Moss [00:16:02] So within that. How have you supported the development of a staff team, practitioner team who can ask these kind of difficult questions sometimes of parents about their children? But to do it in a way that doesn’t reinforce stigma or blame or a punitive approach?

 

Jonathon Main [00:16:19] And that’s a really good question. And on one level I think because we want to take such a holistic approach to it, we immediately are engaging this idea that certain presentations, how things look, isn’t necessarily how they are. So we know, for example, that within a lot of the family services that it can be, particularly if people aren’t necessarily presenting with family violence. But is a background issue that we discover subsequently is present. It’s very easy for a person to present themselves or to be understood by a service as the parenting problem understood in terms of how they’re having difficulties managing the child’s behaviour. That can often, in the context of family violence, be referenced against poor parenting on behalf of the mother. So these notions that mother blame can often be a tripping up point within services if you don’t have enough information about what’s going on in that person’s life or that child’s life. So within the context of providing, lets say a family, a child focus service. A lot of the support to staff is helping them look at what sense they make of the information that’s come from Doors. Being, again, really clear that Doors is a self report. It’s not an administered assessment process that’s led by practitioners. So it’s not just me as a practitioner doing this piece of work, but actually I now understood that there’s drug and alcohol issues and now I’m getting a bit concerned by what the Doors self reports that there’s a bit of a discrepancy here. I’m wondering what that means. Maybe I should be talking to a practice lead or a practice manager in relation to this. So these are the kinds of things that we have in our client information system that helps trigger how do you engage the broader care team. Which effectively becomes like an internal case conference. Who else do we need to be engaging? Have we engaged everyone else in terms of other services that need to be engaged? Do we need to, in fact, convene a case conference with other agencies and other sectors? So how do we know that we’re working both together in the interagency wraparound sense, but how we’re we working well ourselves with our own work, lining up with what we’ve been hearing from clients through screening at our own risk assessment.

 

Dan Moss [00:18:35] So as part of these processes and maybe other processes. Is there a sense of confidence within your organisation that all practitioners are operating from a consistent child focus point of view?

 

Jonathon Main [00:18:49] I think as we move through the various challenges that all organisations face around recognising that when you implement anything. Whether it’s a risk screening system like doors, a clinical governance system, a child inclusive practice or child focussed practice framework, you never just implement it and tick it’s done. You know, it’s always about then what do you do to help maintain and sustain those systems? So for us within our organisation we do that continually through that process of supervision. We but it’s also important because we are data driven as well. It’s important we don’t just say we do. We say were is the evidence of that.

 

Dan Moss [00:19:31] Are there explicit expectations in a practitioners’ performance appraisal or professional development systems, which asks them to demonstrate core competencies around child focussed practice?

 

Jonathon Main [00:19:46] We do that probably mainly through. So, again, actually, if you go back to our own review process. All practitioner staff, or all staff  in fact, have an annual review with the line manager. For our practitioner staff, recognising that they have practice supervision in some instances, group supervision depending on the area. There are practice supervisors who then have a relationship and a knowledge of that that person’s practice across the year. What we’ve done is made sure that the annual review process, which is still a management-led process, has feeding into that. A separate annual practice supervision review that is conducted while the practice supervisor with the practitioner. And that’s done about three months ahead of our annual review process, so that the management supervisor who’s leading the annual review process with the staff member, has for herself or himself, a copy of their annual practice supervision review. So that annual practice supervision review is to make sure that we’re not just saying we’re gonna do it on the management side of the equation, but from a clinical governance perspective, we want the practice supervisor to be asked to review with their practitioner all of what they’d be doing across the course of the year. So central to that, there are a number of key things. One of them is around our cultural fitness and our practice around working with Aboriginal and Torres Strait Islander families and communities. Another one is in relation to family and domestic violence issues. Another one is in relation to our working with children and being child focussed. And we didn’t realise, for example, that amount and that figure I quoted earlier than two thirds of people who present to our services are parents of dependent children. Without knowing that, we might not have even thought to say, well, is there a child lense that we could be asking about this person’s presenting concerns?

 

Dan Moss [00:21:35] Okay. So, Jonathon, I’m interested when a parent does come in to an adult focus service and answers a question on the Family Door screening tool, which might alert you to the fact that there are some some issues which might be affecting the social and emotional well-being of their child. How that is kind of picked up in subsequent mechanisms in your organisation, for example, do case reviews allow practitioners time to reflect on whether there’s been some practices which have helped that parent get clear about their or someone else’s concerns?

 

Jonathon Main [00:22:14] When people are completing the case notes within our client information system, the workflows identify when we say, ‘well okay, there are issues around social and emotional wellbeing for these children’. We know that from our client information system, then it means that any flags that arise in the context of the Door screen or our subsequent risk assessment. So given that we’ve got information, parents self-report. That has asked the opportunity to ask into the issues that have been raised through the screen, and from that we then assess the risks that we see for that child’s social emotional wellbeing. And if there are particular risk or safety concerns or a particular resilience factors that we pick up, then that gives us the opportunity to respond to those at that time. Now, part of that process also means that it includes and enables a risk assessment or risk escalation process. So we’re for example, we see risks. And it might be, for example, that there’s a reference to child safety, which is not clear in a follow up conversation with a parent. That then gives us the opportunity to to ask into that more and to say, ‘well, we noticed he talked about harsher than usual parenting’, that’s one of the screening questions we’ll ask about. And if a person has expressed that they feel that their parenting has being harsher than usual, then what does that mean in terms of what’s going on for you and what’s going on for your child? What does that mean in terms of what your child might have been experiencing?

 

[00:23:50] Now, again, we might have a parent in a position where they’re telling us very clearly what’s going on and it might be their behaviour it might be the other parents’ behaviour. Or we might otherwise have concern that what we’re hearing may not account for everything that we we see in front of us. And so that then will have us saying, well, I think there may be a child protection risk here for example, then if I need to make a notification, then in our process that becomes a serious and complex matter. And that then invokes, who do I need to consult with? So I’ll at least consult with my line manager. I might consult with my practice supervisor. It may become escalated from there to include a practice manager or another person in the line management change depending on the nature of the risk and the seriousness of it. So that’s a way of making sure that when flags are raised, we respond to them. We can see how they responded to by the practitioner through our supervision and clinical governance processes. When a serious and complex matter comes up in our system, it is then signed off in our client information system by the relevant line manager and next line manager from there. So that way we make sure that no individual practitioner is left with managing risks which are unknown to our broader clinical governance system.

 

Dan Moss [00:25:08] Fantastic. Thank you very much for your time, Jonathon. I appreciate it.

 

Narrator [00:25:14] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.